Avoiding Burnout In Private Practice
Like many physicians, I started to feel burnout this past 6 months. Patients more than ever have been demanding various different things from me. Each demand seemed to chip away at my happiness in the profession. This ranges from getting yelled at demanding to change our mask policy to patients messaging me arguing why do they have to pay for a visit when they can see their lab results on Quest.
One day I was complaining to my co worker about my frustrations. That is when it hit me. My “problem” patients were patients that I kept giving a little more into their demands. Suddenly I realized that I was in some degree to blame for my own burnout.
When I started my practice, I was hungry for business and accepted any patient who came my way. I was so focused on getting patients in the door that I did not focus on protocols for difficult patients. Once I was up and running, I then switched to focusing on surviving the pandemic. Somewhere along the way I lost sight of good clear protocols for patient demands. It started to cost me my happiness.
This is how I helped avoid burnout and regain enjoying practicing medicine again.
There was a period of a few months in early 2021 were I seriously felt myself getting burnt out. I used to wake up and could never envision myself doing anything else. Now, each day I as I drove to work I was plotting my escape from medicine.
The line between being a physician and being a person seemed to be non existent. I felt like I was acting like a concierge physician to all my patients without the concierge pay. That was a big problem. It was leading to me burning out.
Patients had no boundaries to get ahold of me. Patients had the ability to:
- Call after hours and leave a voicemail to request call back
- Message in via our HIPAA compliant app at any hour of the day or night
- Text our office via a texting line
- Requests refills online at any time
- Call in during office hours and talk to my staff
I felt like I was answering patient messages from the moment I was awake until I fell asleep. I finally had a moment when I realized something had to change. One day I implemented some big changes to my private practice and updated my patients. Once I implemented these changes, happiness in my career went right back to where it was before I started to feel burnt out.
Boundaries Boundaries Boundaries To Avoid Burnout
In light of the pandemic, I will admit that I was more generous with being forgiving with patients. Let me try to elaborate.
Patent says they are too afraid to come in to the office?
I understood I thought back in 2020. We are in the middle of a pandemic. A lot of my patients have chronic illnesses putting them at higher risk. I unknowingly started a feedback loop of excuses.
“My video camera does not work”
“My internet is too slow to do a telemed visit”
Just to name two excuses as above. Patients would give me some sort of excuse. Then, I would find myself feeling sorry for them and putting in refills for their medication for a 30 day supply. We would tell them to follow up by the time those refills ran out. However, when that refill was up, a new excuse seemed to arise with them needing just one more refill…
Patients continued to call in and say:
“Why Can’t He Give Me The Medication, He Did It Last Time Without A Visit”
There it is.
I was enabling bad behavior even though I had the best intentions to keep my patients healthy and safe.
Every time I gave an inch, some patients seemed to try to take a mile. There was a delicate balance in my mind about trying to keep my patients safe from COVID while practicing great medicine. However, I inadvertently trained my patients that I can in fact give refills (at the risk of my license) without a formal follow up.
Protocols For The Clinic
Once I identified the problem, the next step was taking action.
My first action point was creating new, clear protocols for the practice.
This way my staff had written down examples of what to do when a patient calls in or requests a certain medications. Once I had this in place I emailed it to my staff. We also hung it on the wall for flow charts for med refills, and then implemented the rule.
A mass email went also out to my patients informing them of this change.
Pushback And Unhappy Patients
Most of my patients were on board with these changes. However, a small percentage of patients gave us immense pushback to this rule change.
We had one patient yell at us because they didn’t feel that they needed to be seen for their diabetes care. I kept messaging her on our HIPAA compliant app, more or less pleading with her that she needs to come in so that we can get control of her diabetes.
Her A1c, has been hovering at 14 for about a year now. I kept messaging about how it is imperative that we see her to help minimize her risk of complications from this issue.
She kept giving me sad story after sad story until one day after our protocol went live I said…enough. No more free care, no more refills for a sad story.
She called in to cuss at us about how terrible of a clinic we were to “abandon” her like this. We reminded her that we gave her numerous opportunities to do a virtual visit or come into the office but she always had an excuse why that can not happen.
We offered her same day appointments, which she declined due to yet another excuse.
In the end she cussed at my staff even more and I sent her a termination letter for our clinic.
Hours Wasted Because Of My Enabling Bad Behavior
I looked back at her chart and my jaw dropped just how out of control things have gotten by me enabling bad behavior.
She had not physically been seen in a year and there were 44 messages in her portal since then were she kept weaseling her way into my staff putting in a a1c check and then creating so many excuses why she can not even do a virtual visit to go over that lab result. Then, excuses about how she is “going to die” if she does not get her insulin refilled and more excuses after excuses for not following up.
I estimate that I wasted 2 hours on this patient alone with the back and forth communication, begging her to come into the clinic and messaging my staff to call her and get her on the schedule. Then to go back and forth about how to deal with her new excuse.
I really let things get way out of control with this just one example of patient bad behavior.
Do Not Care More About The Patients Disease Than They Do
When I feel like I let anything in my life get out of the boundaries that I previously would have liked it to, I always try to look back and see what happened.
- I cared more about her disease and diabetic control than she did.
- I let her get away with numerous counts of free healthcare without digging my feet in the sand eariler and sticking to my boundaries.
- There was a total lack of clear protocols for my staff for med refills, so they were all lacking guidance about how to deal with patients like this.
- Patients who do not value me as a physician are better served at another clinic.
You NEED Protocols In Your Private Practice
My first goal when I opened my doors was getting patients in the door. As problems came up, I figured I would handle it one problem at a time and focus on growth first.
I never would have guessed that the pandemic would sucker punch us the way that this one did. So, while I was focused on my business surviving the pandemic, I forgot to focus on updating protocols that were not directly related to COVID protocols.
My staff bugged me numerous times per day to ask what to do with patient questions. They did this because I did not have a clear written policy. I was creating all the problems that was leading to burnout in myself.
It is a sad moment when you realize that you are the reason you are in a situation that you don’t enjoy being in. However, the hard part is identifying the problem. Once I had the hard truth, I had to implement my changes.
Just like children need structure in their life, your employees will need structure in how to deal with common things that will come up day to day. If you find yourself getting stressed with the same issue over and over again, take a step back and create a protocol to correct it before it gets out of control like my problem did.
- Print out instructions at the end of each visit with clear message on when to follow up.
- If a patient does not follow up at that time for a new medication, no refills will be sent in until there is a follow up appointment on the schedule within the following 2 weeks.
- If a patient needs a refill for a non controlled substance that is not new to the medication, then we put them on the schedule for a follow up and give them enough refills to get them to that follow up which has to be less than 14 days in the future.
- After hours messaging platforms have clear boundaries that we are out of the office and will answer their question during regular business hours. If there is an emergency, to go to the ER.
- Booking follow up visits at the time of the visit. If a patient chooses not to book a follow up visit, we remind them that no refills of the medication and that they need to book a follow up visit for any refills.
- No discounts. No waived copays.
COVID And Tunnel Vision
I was so focused on clinic protocols to avoid getting my staff sick, myself sick, or patients sick due to COVID that I let other protocols slide.
There also was a time when business was way down during the pandemic. For a brief time, I was worried how my business might survive.
I was so focused on these other things that I lost sight of myself getting frustrated by patient messages and refills when I could have simply updated my protocols and stuck to them.
A balance is needed in life, and a huge part of that is structure. My clinic lacked written structure.
By creating clear written protocols for my staff, I feel like I took happiness back in my practice by creating balance and structure with well defined boundaries for those patients who like to push things to see how much free healthcare they can receive.
If you are feeling burnt out, take a step back and see if just maybe you too got tunnel vision and maybe protocols to create better defined boundaries might help.
6 thoughts on “Avoiding Burnout In Private Practice”
I love these posts. So real and honest thanks for sharing. I’m sure you’ve done it already but I’d change the “story” of the patient enough when you’re sharing it that it can’t get traced back to her. But I genuinely love these shared experiences because the next time around I really wanna know how to prevent burnout.
Thanks! It was tough to write it all out, realizing that I was creating so much of the problem for myself. However, a good learning point to take a step back and work on improving the process to see if that can help avoid burnout.
Really appreciate the write-up. Back in residency, I worked with a doc whose rule was basically “rx refills are ONLY done at appointments”. he said it was great, all the patients knew the rule, he didn’t have a constant inbox of rx refill requests.
I think that is a great rule to have. It gets a little touch because some patients will tell me…no don’t refill that now, I’ll call you in a month for the refill.
Having a clear protocol and good boundaries is a good way to help ensure happiness in the work environment.
Great read; thanks for sharing your thoughts and practices
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